Provider Demographics
NPI:1235551375
Name:PAYNE, REBECCA KAY (LVN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W RICHERT AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-5047
Mailing Address - Country:US
Mailing Address - Phone:559-392-2143
Mailing Address - Fax:
Practice Address - Street 1:236 W RICHERT AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-5047
Practice Address - Country:US
Practice Address - Phone:559-392-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 268296164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse